Here's a simple way to determine whether your health plan is working: Can you see a doctor right away when you get sick or injured?

Sadly, for many Californians served by Medi-Cal, the answer is no. And that should be alarming to anyone who wants Congress to pass meaningful health care reform in coming weeks.

That's because a key element of legislation being reconciled by congressional leaders is expanding eligibility for Medicaid, known in California as Medi-Cal. This could add up to 2 million patients to a program that already serves 6.5 million poor Californians. But that makes no more sense than building a house on a sloping, cracked foundation.

Here's what we know: Health care works best when patients can see doctors easily and regularly. Primary care physicians can help guide their patients to healthy lifestyles and address problems as they begin to emerge. This not only makes the best medical sense, but it also makes the best fiscal sense.

That doesn't happen when patients can't see their doctors, however. And Medi-Cal, unfortunately, illustrates the effects. Medi-Cal patients get sicker and end up visiting overcrowded emergency rooms more frequently. According to a 2006 California Healthcare Foundation study, 31 percent of Medi-Cal recipients reported going to the emergency room at some point in the past 12 months, twice the rate of average Californians.

Why does this happen? Because the Medi-Cal system is so poorly funded, only about one-third of the state's physicians participate. That means Medi-Cal patients have a tough time finding a doctor. Some have to wait months to get an appointment, and others have to drive an hour or more.

Like many doctors, I believe in universal access to health care. So the idea of expanding Medi-Cal to cover many of California's uninsured is not a bad one - as long as the program works. But for many patients, Medi-Cal doesn't work, and pouring more people into the program without fixing it will only make matters worse.

Everyone understands the need to rein in rising health care costs. Done right, though, health care reform will save the nation hundreds of billions of dollars by preventing unhealthy conditions, such as obesity. (Obesity-related diseases alone cost the nation $147 billion a year, according to the U.S. Centers for Disease Control and Prevention.)

The point is, there is no way to reap the tremendous long-term savings universal access to health care can provide if Congress doesn't appropriately fund reform and ensure that patients can get access to doctors when they need it.

Both health reform bills - the one passed by the House on Nov. 7 and the one approved by the Senate on Dec. 24 - must better fund Medicaid in order to make expanding it viable. Congressional leaders are working to merge the two bills, which have big differences, into one final product.

The House bill acknowledges the dangerous threat to access posed by inadequate reimbursement rates and makes an effort to raise payments to reasonable levels.

The Senate legislation, though, is entirely unacceptable and would jeopardize access to care for senior citizens and millions of poor and unemployed who would be under the false illusion that they have reliable health coverage. It makes no changes in low Medicaid reimbursement rates for physicians and allows deep cuts in doctors' Medicare payments in coming years.

If we want health reform to be effective - to provide access to doctors when patients need it - then we must sufficiently fund the system. That's the lesson of Medi-Cal. It's time to learn from it.

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